1. Field of the Invention
The present invention generally relates to surgical systems. More particularly, the present invention relates to a system and method for minimizing the effect of motion due to a heartbeat during the performance of minimally invasive endoscopic surgical procedures and more particularly endoscopic coronary artery bypass grafting surgery.
2. Description of Related Art
Blockage of a coronary artery may deprive the heart of the blood and oxygen required to sustain life. The blockage may be removed with medication or by an angioplasty. For severe blockage, a coronary artery bypass graft (CABG) is performed to bypass the blocked area of the artery. CABG procedures are typically performed by splitting the sternum and pulling open the chest cavity to provide access to the heart. An incision is made in the artery adjacent to the blocked area. The internal mammary artery (IMA) or some other arterial source of blood-flow may then be severed and attached to the artery at the point of incision The IMA bypasses the blocked area of the artery to again provide a full flow of blood to the heart.
Splitting the sternum and opening the chest cavity can create tremendous trauma on the patient. Additionally, the cracked sternum prolongs the recovery period of the patient. As such, there have been developed systems that enable minimally invasive CABG procedures. These systems utilize hand held tools and small incisions, on the order of 3-5 inches in length, to provide access to the thoracic region of a patient.
Such minimally invasive procedures are conducted by inserting surgical instruments through small incisions, on the order of inches in the skin of the patient. Manipulating such instruments can be awkward, particularly when suturing a graft to an artery. These systems utilize direct visualization of the surgical site. Such systems do not enable a completely endoscopic approach to the CABG procedure because of the need for direct visualization of the site. Additionally, such systems do not enable a fully endoscopic approach because of the incision size necessary to adequately manipulate the surgical instruments at the surgical site.
A fully endoscopic approach utilizes small holes to provide access to the thoracic cavity. Each of these holes is on the order of 3-15 mm in diameter. In order to perform a CABG procedure in a fully endoscopic fashion (i.e. using 3-10 mm holes) a robotic system must be used to filter hand tremors and scale motions made by the surgeon.
One of the greatest risks a patient faces during a CABG procedure, whether it be performed open, or in a minimally invasive fashion, is the use of cardiopulmonary bypass (CPB). It has been found that the use of CPB may result in short and long term memory loss, stroke, edema, and a host of other problems related to the use of such a system.
Systems that are currently being used to perform minimally invasive CABG procedures, and all known systems that enable a fully endoscopic approach to the CABG procedure employ CPB. The patient's heart is stopped and the blood-flow that would normally reach the heart is fed through a machine which oxygenates the blood and feeds it back into the patient's bloodstream. Once the patient has been placed on CPB, the bypass procedure is performed on the stilled heart.
It is heretofore unknown to perform a fully endoscopic CABG procedure on a beating heart. This is because there is no apparatus or method for minimizing or eliminating the effects of a heartbeat during the procedure.
It is essential that the heart remain still so as to enable minimally invasive endoscopic CABG procedures. More particularly, the sutures that must be emplaced on the arteries are on the order of between 1 and 4 millimeters. During a minimally invasive CABG procedure, movement of the heart makes it essentially impossible to perform the procedure. As such, CPB may be currently used in an endoscopic CABG procedure.
To minimize risk to the patient, and to minimize operating time, what is needed in the art is a system that replaces conventional CPB for use in endoscopic CABG procedures. Such a system may minimize the motion of the heart such that a patient's heart need not be completely stopped and the patient need not be placed on CPB. Such a system may be used in conjunction with a robotic system for endoscopic surgeries such as that referred to hereinabove wherein such a system will include apparatus for measuring and compensating for or correcting for heart motion.